FORM BHAC20 12-09-14 Rev. 3 PROCESS SAFETY MANAGEMENT INQUIRY RE-EVALUATION OF HAZARDOUS AREA CLASSIFICATION REQUEST FORM Company Name Project Sponsor Project Name Project Manager Requested By Project Number Best Contact Number Best Contact Email Date Bath Project No: PROJECT DESCRIPTION: dsfsdf H.A.C. Assessment Due Date: Information required for Re-evaluation of Hazardous Area Classification (HAC) from client: 1) Scaled plot plans: These drawings should reflect the as-built status of the equipment location. The drawings are used as the base map for the Hazardous Area Classification drawings. 2) Current Process Flow Diagrams: Drawings should show stream numbers and process information such as flow rates, pressures, and temperatures. The stream numbers should correlate directly with the material Page 1 of 3 FORM BHAC20 12-09-14 Rev. 3 balance stream numbers. (If possible the material balance information needs to be in a MS Excel electronic file). 3) Heat and Material Balance: Information should include all pure components for each stream in weight percent (if possible). These streams need to be related by stream number to the PFD’s. (This data is used by Bath to create each stream that is used in gas/vapor dispersion modeling). 4) Current Process & Instrumentation Diagrams (P&ID’s): These documents define equipment numbers, names, and set the scope for the project. 5) Material Safety Data Sheets (MSDS): Each MSDS should be assigned to the appropriate process stream or process equipment. Deliverables from Bath Engineering to Client: 1) Area Classification drawings which include but are not limited to: a) Plan Drawings referenced to the scaled plot plan background/base map provided. b) Enlarged Plan Drawings (used where the area is congested with process equipment). Drawing is referenced back to the master background/base map plan drawings. c) Elevation Drawings (when there is a multi-level process structure with different process equipment at each level). Plan drawings are also included for each structural level. d) Drawings that contain equipment details, tables, notes, and legends 2) Hazardous Area Classification Assessment Report: A detailed audit proof document covering the assessment having the following sections: Section A General Considerations Section B Identification of Point Sources of Emissions Section C Physical Properties of Materials Being Handled, Processed, or Stored Section D Classification Rational Section E Special Exceptions Section F List of Area Classification Drawings Section G Stream MESG Calculations Section H Gas Dispersion Modeling Graphs and Plots 3) Compliance Assessment Report: Documentation of general & specific findings. 4) The final documentation will be presented to client based on client requirements. Page 2 of 3 FORM BHAC20 I. 12-09-14 Rev. 3 Project Information Required To Prepare an Estimate of Cost to Complete Re-Evaluation Of Hazardous Area Classification Available Yes No N/A Qty. Notes 1. Current/Updated Scaled Plot Plans? 1a. Is a field verification of current/updated scaled plot plans required? 2. Current Process Flow Diagrams? 3. Heat and Material Balance Information? 3a. In MS Excel? 4. Current Process & Instrumentation Diagrams (P&ID’s)? 5. Material Safety Data Sheets? 6. Other: (i.e. Isometric drawings, pump spec sheets, etc.) II. PLEASE EMAIL ABOVE INFORMATION IN PDF FORMAT TO PSM@BATHGROUP.COM. THIS INFORMATION IS REQUIRED IN ORDER FOR BATH TO COMPLETE A COST ESTIMATE. TERMS FOR THIS CHANGE AUTHORIZATION Based on the information above, Bath Process Safety Management will estimate the number of hours and cost for professional services required. A written proposal complete with specific terms and conditions will be provided. Approved by: For Client Date For Bath Process Safety Management Date Page 3 of 3